‘Locked-in’ ALS patients get a voice thanks to this new mind-reading machine

For decades, one of the most
troubling difficulties of treating patients with certain types of
neurological disorders has been the complete inability of doctors to
communicate with these patients, in any fashion. Modern technology has
helped millions of physically or mentally disabled persons express
themselves or better communicate with caretakers, but locked-in syndrome
has been extremely difficult to treat. Now researchers from Europe have
used a brain-computer interface to communicate with four completely
locked-in ALS patients.

Locked-in syndrome means that patients can’t
communicate, even though they’re still “in there.” One patient in this
report had been locked in since 2014. Another had been stricken by
early-onset ALS at just 23, and the terrible march of the disease had
taken just two years, from diagnosis to being completely locked in. It
seems obvious — can’t we just look at brain waves to see what people are
trying to say? But brain-computer interfaces are still in their
relative infancy. Even though DARPA is pouring a bunch of money into
different BCI projects, they’re still pretty much bespoke applications
for small-scale projects.

Image by the Wyss Center

Designed by lead author Niels Birbaumer, a
neuroscientist working at the Wyss Center for Bio and Neuroengineering
in Geneva, this particular brain-computer interface
fits on a person’s head like a beanie. It uses an EEG to measure
changes in electrical activity in the brain, and also monitors blood
flow using a technique known as near-infrared spectroscopy.

After obtaining informed consent, Birbaumer’s
team asked patients to work with them to calibrate the BCI, by thinking
“YES” or “NO” — and yes, thinking in caps lock, because that’s louder
than regular thinking. The researchers wanted the patients to think that
one single thought, yes or no, as loudly and clearly and emphatically
and single-mindedly as they could. [Who knew all the depictions of psionics I read in bad fantasy were accurate? — Ed] If
possible, too, the researchers asked the patients to try to do whatever
communication techniques they’d been able to use before, hoping to use
the EEG results in combination with a neuromuscular map to refine
results.

These people had been locked in for years, but
they were still cogent and capable, and they all worked patiently with
the researchers. They wore the EEG caps and answered pair after pair of
related yes-no questions (“Paris is the capital of France”—”yes”; “Paris
is the capital of Germany”—”no”). At the end, each patient had a
personal, carefully calibrated model of what their brain looked like
when they were thinking “yes” or “no.”

Then the researchers started asking questions
in earnest. Asking about the important stuff. “Your husband’s name is
Joachim.” (“Yes.”) “You have back pain.” (“No.”) “You are happy to be
alive.” (“Yes.”) Birbaumer told the MIT Technology Review that “the
relief was enormous” for the families, after hearing the affirmative
responses from relatives they’d expected never to be able to communicate
with again.

The technique the researchers used wasn’t
foolproof — even though many of the questions had known answers,
respondents only gave the “correct” answers roughly 70% of the time, and
it’s not clear why. Some may have had attention span issues, and at
least one was partially blind — and there may have been concurrent
problems with other neurons, confounding results. Some issues may also
remain to be worked out on the technology platform. But it won’t be long
before we’re seeing recent advances in brain mapping represented in
applications like this, with attendant leaps in quality and capability.
Who’s ready to start taking bets on how long it’ll be before we have an
all-external method of brain mapping with sub-1mm resolution?

‘Locked-in’ ALS patients get a voice thanks to this new mind-reading machine
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